MEDICARE: BRIANA OMATTO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	041442575	IL
2	363LF0000X	Family Nurse Practitioner	209025750	IL

General Provider Information

NPI Number	:	1215660469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA OMATTO APRN

Provider Business Mailing Address
First Line	:	1051 ESSINGTON ROAD
Second Line	:	SUITE 210
City	:	JOLIET
State	:	IL
Zip	:	60435-2812
Country	:	US
Telephone Number	:	815-726-1818
Fax Number	:	815-726-0232

Provider Business Practice Location Address
First Line	:	1051 ESSINGTON ROAD
Second Line	:	SUITE 210
City	:	JOLIET
State	:	IL
Zip	:	60435-2812
Country	:	US
Telephone Number	:	815-726-1818
Fax Number	:	815-726-0232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	02/21/2023

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